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DEPARTMENT OF BUILDNG INSPECTIONS
212'Maia Street ' Municipal-Building
Northampton, Masi. 01060
WORKER'S COMTENSAITON INSURANCE AjTMA.VTT
(limn_scc/pC,m;acc)
with a principal place of business/residence at:
(phone#)
(str--Uci ty/stalc/ri p)
do hereby certify, under the pains and penalties of perjury, that:
( ) T am an employer providing the following worker's compensation coverage for my
employees working on this job:
gnsuranct Company) (Policy Number) (Expiration Dare)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below-who have the following worker's compensation policies'
(NnrnC of Contractor) (Insurant=Company/policy Number) (Fxpirotion Date)
(Name of Contractor) (Insurance Company/policy Number) •(Expimdon Date)
(Name of Contractor) (Lasurance Companylpoucy Number) (a-piradon Date)
(Name of Contractor) (Insurance Company/Poacy Number) (Expiration Date)
(att.u3,additianat sha!ifneocuary to inc)Udc iotocavaoa paoiain6 to aJr oortrar-on)
( ) I and a sole proprietor and have no one working forme.
(v)'I am a home owner performing all the work myself.
NOTF.plcaac be&w2zv tbst v;biro bomoowvcn wbo cuPloy pcnonr to do m• ooc=ru oo•or rcoalt work on a dymlling of J /
not mom than tbxoo un;U is WEcbtbe bomeo%o rcxido cc oo Lb.PMU06 vpld,: wt tswdo arc cot ca)a-ly aoa:idcrod to Ix
employrra troller tbo%VOC sSc compcat-ion Aa(G LI52fr 1(3)),-fp5mt;oa by•homeowner for a Gacoe oc pcma d may evidcooe the
legal rtJLU"of an employ.0 nodw di a Workoes Compeonatioa Ad
1 aodau+iad d ut a copy of"mtocami=Ay be fogwardod to tbo Dop.rtmmt ofla&utrir]Aod ..&OW—-rloaur■ew foe d-
oovT8--%veX 9d0d txad that f Zv=t*-Out oovcmP uodcr socxioa 23A ofU0L 132 can kid to the imposition cf aimmd pea.ltia
oomiatit:g oCs�ae ta{tr�to S 100.00 rodlor empcitoomcrrt oCtip W ooe yw and dva puartia ro the form ota Stop Work Order aid a
fim oCS100.00 a-day agsicA me ..
Permit Number
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. A Tel.No. J / 4 Alterations
NORTHAMPTON, MASS. a 19 Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location�. 61 /-fir /—/ S r Lot No.
2. Owner's name '-i'-a sZ �q r` ��/���ST// Address S 4-111(Z
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3. Builder's name P -457 Ail 4 Address S NC �=
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost-� U
The undersigned certifies that the above statements are we to the best of his.
know" and belief.
Signature of responsible appicant
Remarks
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' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Mnin Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE: 6
JOB LOCATION:
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER:
(Name & Address ) _o
(Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) families and to allow such
homeowner to engage an individual for hire who does not possess a -
license , provided that the owner acts as supervisor. CMR780 Section 109. 1 . 1
DEFINITION -oF. HOMEOWNER: Person(s ) who own a parcel of land on
which .he/she resides or intends to reside , on which there is, or is
intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be
conside-red a homeowner . Such "homeowner" shall submit to the Building
Official, on a form acceptable to the Building Official, that he/she :
shall be responsible for all such work performed under. the buildin'a
permit'.
As acting Construction Supervisor your presence on the`, job site
will be required from time to time, during and upon completip' n of the
work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers '
Compensation) and Chapter 153 (Liability of Employers to Employees for
injuries not resulting in Death) of the Massachusetts General Laws
Annotated, you may be liable for person( s ) you hire to perform work for
you under this permit .
The undersigned "homeowner" certifies and assumes responsibility
for compliance with the State Building Code , City of . Northampton
ordinances, State and Local Zoning Laws , and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATUF
BUILDING. PEi214IT :liS
.. .�. ... .. rte> -. ..
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DEPARTMENT OF BUILDWG INSPECTIONS
212'Main Street a Municipal Building
Northampton, Mass. 01060 '
WORIcER'S COMPENSATION INSURANCE A.)~');tZDA VIT
. (liccnscrJpermittcc)
with a principal place of business/residence at:
c
(streslaty/statrJap)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following workers compensation coverage for my
einployees working on this job:
ansuranee Company) (Policy Number) (Expiration Date)
( ) lain a sole proprietor, general contractor4om��e one) and have hired
the contractors listed below-who have the following worker's compensation policies:
(Na-me of Contractor) (Ins�=c--Company/PoLicy Number) (Expiration Date)
(Name of Contractor) Ulnsurancc Company/PoGcy Number) (Expiradoa Date)
(Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Corapany/Policy Number) (Expiration Date)
(anxh additional=hcct irnoocaary to mchidc idbmution perhimng to cU coatmeo )
( ) I and a sole proprietor and have no one wort ng for me.
I am a home owner performing all the work myself.
NOTE:plwe be aware chit while bomcowo=wbo employ pcnoat to do v kjc.,•m oor'ructioa•or rcpe.ir work on a dwelling or
not mom than thrroe wait+is which;the bomoowocc midcs oc co tbo praua6 Vpautcaanl tb=W am oot fitly cocaWctcd to be
amploym under tbo%%vek i comptaaatiea Act(GL152,n 1(5)).ap UmSoo by a homcownir fora Gccwc a p—ad may cvidcaoc the
1ega1 rtatsu Ot&4 employs under tbo Worfroea Compemation 4W
-
I undcidaad chit ra copy*("esY1—nd m.y be tomard+d to the DV t a of A-;&W Own.oltaauraooe t«tb.
arvaage vcrifieraiat*a tbat failure W aocttrn sw=ain trade zodti 25A of UOL 152 caa tc+d to tbd imposition of aimk4•pe"W s
oomirtiag of a•one ot'tap to S1,�00 00 aodlot impcuoomcat o[tip to one 7atr rand ava pcaaltia is the form of a Stop Work Order and a ..
Soo ofSltt0.00 a ty*.grit Wei
• FordcQ,atrnadaltwc�y .
Permit Numbe r
(o{( Maps Lot#
„- of Lioc>iscdPcra�tittoa `
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of Signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPI TjED, or PERMIT CAN BE DENIED DOE TO
LACK OF INFORMATION.
This colu= to be filled in
by the Banding Dhepartment
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks frnnt
i
- side L: R: L: R:
i
- rear
i
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking%
# of Parking Spaces
f of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify ';that the information contained herein
is true and accurate to the best of my knowledge.
DATE: ���c APPLICANT's S GNATURE
NOTE: 1"jdan a of a zoning permit does not relieve an pplioanYs bur en to oom wit
zonin Phi M •�11
g requirements and obtain all required) permits from the Board of Health. Conservation
Commission. Department of Public Works and other applicable permit granting authorities.
FILE #
Fi 1 e No Uf
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
- 1. Name of Applicant: `%2I Ch vi Rel
Address: 19,L4 1-11, 1 �G a/%21<NC� &J-9; Telephone: S'�e4 -9-r l y
2. Owner of Property: SJt-a\
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# r Parcel# District(s):
(TO BE FIL ED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
60M'VfQ-f-e mt+sk 102,=2 H*LPE � nr /zonls (Fri
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW_ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
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24 HIGH ST BP-2000-0159
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 17D-038 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:vinl siding BUILDING PERMIT
Permit# BP-2000-0159
Project# JS-2000-0255
Est. Cost:$2800.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size sq.ft.): 5749.92 Owner: FENNESSEY RICHARD A
Zoning:URB Applicant:
AT. 24 HIGH ST
Applicant Address: Phone: Insurance:
ISSUED ON.•81mig99 o:oo:oo
TO PERFORM THE FOLLOWING WORK:I NSTALLS I DING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
i
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/13/1999 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 ,
Building Commissioner-Anthony Patillo
�A HIGH ST BI"
GIs# y COMINIONWEALTH OF MASSACHUSETTS
B ock: 17D-038 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cate&ory:vinyl siding BUILDING PERMIT
Permit# BP-2000-0159
Project# JS-2000-0255 + ';
Est.Cost:$2800.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(%ft.): 5749.92 Owner. FENNESSEY RICHARD A
zoning:URB Applicant
AT.- 2.4 HIGH ST
Applicant Address: Phone: Insurance:
ISSUED ON:8/13/1999 o:oo:oo
TO PERFORM THE FOLLOWING WORK:INSTALLSIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Deaartment Fireplace/Chimney:
Rough: Oil: Insulation:
Final: t►lce: Fay
THIS PERMIT MAY BE REVOKED BY THE CITY opobRTHAmyroN UPON VIOLATION OF
ANY OF ITS RULES AND REGUL ONS.
ertificate of i ature•
'_ '�'ype Receipt Nos Date Paid: Check No: Amount:
Bu 1g 8/13/1999 0:00:00 $100,00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
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GAL NOTIC
'° r Date '
^r i A l
Article f�, Section of the Zoning Ordinance
MHEREAS, violations of rticle , Section of the Building Code have been found on
Section of the Code
-here premises, IT IS HEREBY ORDERED in accordance with the above Code that all persons cease, desist
rom, and
STOP WORK
at once pertaining t® .sfo struction, Alterations or repairs on these premises
known as
ell persons acting contrary to this order or removing or mutilating this notice are liable to arrest
mless such action is authorized by the Depar n%ant.
ouaD 4r,. ffICIAL